Yadav Rajan, Panchal Harsha, Patel Apurva, Parikh Sonia, Shah Kajal
Medical Oncology, Gujarat Cancer & Research Institute (GCRI) and B J Medical College (BJMC), Ahmedabad, IND.
Cureus. 2024 Oct 1;16(10):e70622. doi: 10.7759/cureus.70622. eCollection 2024 Oct.
Chronic myeloid leukemia (CML) treatment in low- and middle-income countries faces significant financial and logistical constraints. In scenarios where second-line tyrosine kinase inhibitors (TKIs) are unavailable or unaffordable, dose escalation of imatinib provides an alternative. This study evaluates the efficacy, safety, and progression-free survival (PFS) outcomes of dose escalation of imatinib in CML patients who experienced suboptimal response or progression on standard doses.
A retrospective analysis of 123 CML patients treated at an Indian university teaching hospital from 2013 to 2016 was conducted. Patients who showed progression on a 400 mg dose of imatinib were escalated to 600 mg, and further to 800 mg if required. Demographic data, progression, and toxicity were analyzed.
Out of 123 patients, 78 (63.4%) showed a complete hematologic response after dose escalation. The median PFS was 48 months, with a three-year PFS rate of 67%. Notable toxicities included Grade 3/4 neutropenia in 15% and gastrointestinal disturbances in 12%. Comparatively, studies suggest that switching to a second-line TKI in similar settings results in a higher PFS; however, our findings underscore that dose escalation of imatinib remains a viable alternative when financial constraints limit access to second-line therapies.
In resource-constrained settings, dose escalation of imatinib can be an effective strategy for managing CML patients who progress on standard doses.
低收入和中等收入国家的慢性髓性白血病（CML）治疗面临重大的财务和后勤限制。在无法获得或负担不起二线酪氨酸激酶抑制剂（TKI）的情况下，伊马替尼剂量递增提供了一种替代方案。本研究评估了在标准剂量下反应欠佳或病情进展的CML患者中伊马替尼剂量递增的疗效、安全性和无进展生存期（PFS）结果。
对2013年至2016年在印度一所大学教学医院接受治疗的123例CML患者进行回顾性分析。在400mg伊马替尼剂量下出现病情进展的患者剂量递增至600mg，如有需要进一步增至800mg。分析人口统计学数据、病情进展和毒性。
123例患者中，78例（63.4%）在剂量递增后出现完全血液学反应。中位PFS为48个月，三年PFS率为67%。显著的毒性包括15%的3/4级中性粒细胞减少和12%的胃肠道紊乱。相比之下，研究表明在类似情况下改用二线TKI可获得更高的PFS；然而，我们的研究结果强调，当财务限制限制了二线治疗的可及性时，伊马替尼剂量递增仍然是一种可行的替代方案。
在资源有限的情况下，伊马替尼剂量递增可以是管理在标准剂量下病情进展的CML患者的有效策略。
